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Exposure to air pollution as an environmental determinant of how Sjögren's disease is expressed at diagnosis

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43
Collaborator/s: X. Dong1, Z. Yan2, X. Li3, L. Wang4, P. Olsson5, T. Mandl6, R. Seror7, X. Mariette8, A. Vissink9, H. Bootsma10, D. Danda11, V.C. Romão12, M. Bandeira13, M. Silvério-António14, R. Solans15, C. Galisteo16, D. Sene17, D. Isenberg18, P. Cipriani19, V. Devauchelle20, T. Gheita21, M. Vázquez22, J. Morel23, S. Consani24, S.-K. Kwok25, S.-H. Park26, M. Kvarnstrom27, M. Wahren-Herlenius28, P.E. Díaz Cuiza29, B. Herrera30, T. Shimizu31, A. González-García32, S. Melchor-Díaz33, M. Bombardieri34, A. Lees35, S. Arends36, E. Treppo37, S. Longhino38, V. Manfrè39, M.T. Rizzo40, A. Sebastian41, P. Wiland42, R. Gerli43, S. Downie-Doyle44, A. Saraux45, G. Nordmark46, C. Morcillo47, L. González-De-Paz48, A. Sisó-Almirall49

 

  1. Autoimmune Diseases Unit, Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Milenium Balmes Sanitas, Barcelona, Spain.
  2. Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.
  3. Newcastle NIHR Biomedical Research Centre, The United Kingdom Primary Sjögren’s Syndrome Registry, Newcastle upon Tyne, UK.
  4. Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary.
  5. Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.
  6. Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy.
  7. Rheumatology Unit, University of Pisa, Italy.
  8. Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
  9. Department of Internal Medicine, Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey.
  10. Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia.
  11. Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
  12. Division of Rheumatology, Department of Medicine, University of Udine, University Hospital Santa Maria della Misericordia, Udine, Italy.
  13. Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico.
  14. Marmara University, School of Medicine, Istanbul, Turkey.
  15. Rheumatology Unit, Department of Medicine, University of Perugia, Italy.
  16. Department of Rheumatology, The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, South Australia, Australia.
  17. Clinica Hospital de Ribeirao Preto Medical School, University of São Paulo, Brazil.
  18. Division of Health Based Evidence, Federal University of São Paulo, Brazil.
  19. Department of Internal Medicine, Carol Davila Central Military Emergency Hospital, Bucharest, Romania.
  20. Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
  21. Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy.
  22. Otorhinolaryngology, Head and Neck Surgery, Medical University Innsbruck, Austria.
  23. Federal University of Espírito Santo, Brazil.
  24. Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Brazil.
  25. Department of Rheumatology, Hospital Quirón Salud, Barcelona, Spain.
  26. IRCCS Galeazzi Orthopedic Institute, Milan, and Rheumatology Unit, University of Messina, Italy.
  27. Department of Internal Medicine, Hospital de Cabueñes, Gijón, Spain.
  28. Department of Internal Medicine, Hospital Joan XXIII, Tarragona, Spain.
  29. Clinical Unit of Rheumatology and Clinical Immunology, University of Rome Campus Biomedico, Rome, Italy.
  30. Division of Haematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, Japan.
  31. Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain.
  32. Newcastle NIHR Biomedical Research Centre, The United Kingdom Primary Sjögren’s Syndrome Registry, Newcastle upon Tyne, UK.
  33. Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary.
  34. Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.
  35. Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy.
  36. Rheumatology Unit, University of Pisa, Italy.
  37. Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
  38. Department of Internal Medicine, Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey.
  39. Department of Rheumatology, University Medical Centre, Ljubljana, and Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia.
  40. Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
  41. Division of Rheumatology, Department of Medicine, University of Udine, University Hospital Santa Maria della Misericordia, Udine, Italy.
  42. Marmara University, School of Medicine, Istanbul, Turkey.
  43. Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, and Department of Medicine, University of Barcelona, Spain. mramos@clinic.cat

  1. Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China.
  2. Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China.
  3. Department of Rheumatology and Immunology, The First Affiliated Hospital of USTC, University of Science and Technology of China (Anhui Provincial Hosipital), Hefei, China.
  4. Department of Rheumatology and Immunology, The First Affiliated Hospital of USTC, University of Science and Technology of China (Anhui Provincial Hosipital), Hefei, China.
  5. Department of Rheumatology, Skane University Hospital Malmö, Lund University, Lund, Sweden.
  6. Department of Rheumatology, Skane University Hospital Malmö, Lund University, Lund, Sweden.
  7. Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Sud, INSERM, Paris, France.
  8. Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Sud, INSERM, Paris, France.
  9. Department of Oral and Maxillofacial Surger, University of Groningen, University Medical Center Groningen, The Netherlands.
  10. Department of Oral and Maxillofacial Surger, University of Groningen, University Medical Center Groningen, The Netherlands.
  11. Department of Clinical Immunology & Rheumatology, Christian Medical College & Hospital, Vellore, India.
  12. Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal.
  13. Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal.
  14. Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal.
  15. Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain.
  16. Department of Rheumatology, Hospital Parc Taulí, Barcelona, Spain.
  17. Hôpital Lariboisière, Paris, France.
  18. University College of London, UK.
  19. Clinical Unit of Rheumatology, University of l'Aquila, School of Medicine, L'Aquila, Italy.
  20. Cavale Blanche-University Hospital, Brest, France.
  21. Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.
  22. Department of Rheumatology, Hospital de Clínicas, San Lorenzo, Paraguay.
  23. Department of Rheumatology, Teaching hospital and University of Montpellier, France.
  24. Internal Medicine, Hospital Maciel, and Universidad de la República (UdelaR), Montevideo, Uruguay.
  25. Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
  26. Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
  27. Department of Medicine, Solna, Division of Experimental Rheumatology, Karolinska Institutet, and Karolinska University Hospital, Stockholm.
  28. Department of Medicine, Solna, Division of Experimental Rheumatology, Karolinska Institutet, and Karolinska University Hospital, Stockholm.
  29. Departamento de Reumatología del Seguro Social Universitario y consultorio privado de Reumatología, Sucre, Bolivia.
  30. Departamento de Reumatología del Seguro Social Universitario y consultorio privado de Reumatología, Sucre, Bolivia.
  31. Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
  32. Department of Internal Medicine, Hospital 12 de Octubre, Madrid, Spain.
  33. Department of Rheumatology, Hospital 12 de Octubre, Madrid, Spain.
  34. Queen Mary University of London, UK.
  35. Westmead Hospital, Sydeney, Australia.
  36. Department of Rheumatology & Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands.
  37. Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital Santa Maria della Misericordia, Udine, Italy.
  38. Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital Santa Maria della Misericordia, Udine, Italy.
  39. Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital Santa Maria della Misericordia, Udine, Italy.
  40. Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital Santa Maria della Misericordia, Udine, Italy.
  41. Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland.
  42. Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland.
  43. Rheumatology Unit, Department of Medicine, University of Perugia, Italy.
  44. Department of Rheumatology, The Queen Elizabeth Hospital, University of Adelaide, South Australia, Australia.
  45. Rheumatology Department, Brest University, INSERM 1227, Brest, France.
  46. Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
  47. Hospital Digital Sanitas, Hospital CIMA- Sanitas, Barcelona, Spain.
  48. Primary Healthcare Transversal Research Group, IDIBAPS, Primary Care Center Les Corts, CAPSBE, Barcelona, Spain.
  49. Primary Healthcare Transversal Research Group, IDIBAPS, Primary Care Center Les Corts, CAPSBE, Barcelona, Spain.

on behalf of the Sjögren Big Data Consortium

CER17261
2023 Vol.41, N°12
PI 2448, PF 2457
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PMID: 38019154 [PubMed]

Received: 02/11/2023
Accepted : 03/11/2023
In Press: 29/11/2023
Published: 23/12/2023

Abstract

OBJECTIVES:
To analyse how the potential exposure to air pollutants can influence the key components at the time of diagnosis of Sjögren’s phenotype (epidemiological profile, sicca symptoms, and systemic disease).
METHODS:
For the present study, the following variables were selected for harmonization and refinement: age, sex, country, fulfilment of 2002/2016 criteria items, dry eyes, dry mouth, and overall ESSDAI score. Air pollution indexes per country were defined according to the OECD (1990-2021), including emission data of nitrogen and sulphur oxides (NO/SO), particulate matter (PM2.5 and 1.0), carbon monoxide (CO) and volatile organic compounds (VOC) calculated per unit of GDP, Kg per 1000 USD.
RESULTS:
The results of the chi-square tests of independence for each air pollutant with the frequency of dry eyes at diagnosis showed that, except for one, all variables exhibited p-values <0.0001. The most pronounced disparities emerged in the dry eye prevalence among individuals inhabiting countries with the highest NO/SO exposure, a surge of 4.61 percentage points compared to other countries, followed by CO (3.59 points), non-methane (3.32 points), PM2.5 (3.30 points), and PM1.0 (1.60 points) exposures. Concerning dry mouth, individuals residing in countries with worse NO/SO exposures exhibited a heightened frequency of dry mouth by 2.05 percentage points (p<0.0001), followed by non-methane exposure (1.21 percentage points increase, p=0.007). Individuals inhabiting countries with the worst NO/SO, CO, and PM2.5 pollution levels had a higher mean global ESSDAI score than those in lower-risk nations (all p-values <0.0001). When systemic disease was stratified according to DAS into low, moderate, and high systemic activity levels, a heightened proportion of individuals manifesting moderate/severe systemic activity was observed in countries with worse exposures to NO/SO, CO, and PM2.5 pollutant levels.
CONCLUSIONS:
For the first time, we suggest that pollution levels could influence how SjD appears at diagnosis in a large international cohort of patients. The most notable relationships were found between symptoms (dryness and general body symptoms) and NO/SO, CO, and PM2.5 levels.

DOI: https://doi.org/10.55563/clinexprheumatol/p1r1j4

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